I haven't heard that Medicare would rather have pt's in the hospital, can you explain why? (Not being sarcastic, but what is the benefit to them?)
Sorry to hear that your experience has been so bad. Oasis is ridiculous for all those readmits, esp for frequent flyers. I have decided all I will answer on recerts is the MO### questions, you know those are all you are mandated to answer, right? Now, as to your agency's policy, well that's a diff story.
My agency also pays me by the hour, so I make out OK, I would always choose hourly vs visit rate if I had a choice personally.
I suspect the reason your #'s are down is b/c your agency has become more selective in the admits they will accept. My former agency refused to accept daily wounds if there was not a willing caregiver in the home to teach. We absolutely would not take any BID anything, and we didn't take back known difficult or non-compliant pt's. Your agency is probably being more selective, and so less referrals are coming their way.
AS for 5-7W1 or W2, just for teaching, that is interesting. I have never worked in an agency that would endorse that. No wonder you're feeling so bad. Hard to go from that kind of teaching luxury to just a few visits. But think of it this way, you are still providing a valuable service. How many times have you called to setup a new pt appointment and they have said ,"We're so glad you're coming, I need to ask you....." You will learn how to select the most improtant things a pt should know for visit one, etc. Carepath's can help you with this.
I hope you hang in there, try to find an agency that pays hourly in your area, maybe its just your agency that is going down the toilet, while many nurses are/have left due to PPS/OASIS doodoo, many of us have weathered the storm, and we're doing OK. Best of luck to you, we need good HH nurses.